Facility Evaluation Report

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an announced Case Management visit to the facility. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Emma Hamto. Today's visit was in response to the unexpected passing of Licensee/Administrator Teresita Roxas, who passed away 06/26/26.

During today's visit, LPA conducted a wellness check at the facility and briefly chatted with residents. When LPA was reviewing staff records, LPA noted that two (2) staff members present at the home (identified as S1 and S2) were not included on the facility's association roster. Review of the files for S1 and S2 revealed that both did not have complete documentation of background clearances or associations in their files. Review of the Guardian background check database revealed both S1 and S2 did have eligible background clearances, but that they were not associated to the facility. Per interviews with S1 and S2, S1 had been working at the facility for 3 years and S2 for about 2 years.

One type A Deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached LIC 809-D for the two (2) staff working without having their clearances associated to the facility. In addition, Civil Penalties are being assessed for the total amount of $1,000.00. Details are noted on the attached LIC 421BG form.

One deficiency was cited during the inspection. An exit interview was conducted with caregiver Griffith to whom a copy of this report, the LIC 421BG, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.